ANNU 201819 ANNUAL REPORT … · community services. None of us missed the heartening news of the...

ANNUAL REPORTANNUAL

2018 - 2019

1WESTCOAST PHOANNUAL REPORT 2018-19

2 WESTCOAST PHOANNUAL REPORT 2018-19

Trustees’ report 2Executive Officer’s report 4Subsidising routine access to primary care 6Access for Māori 8Keeping People Healthy 9Breastfeeding 9Health Promotion Community Activity 13Green Prescription 16Green Prescription Plus 17Melon Weight Loss Programme 18General Practice Nutrition Clinics 20Living Well with Diabetes 20Clinical Programmes and Services 21Screening for Cardiovascular Disease and Diabetes 21Treatment for those identified with High Cardiovascular Risk 22Long Term Conditions (LTC) Programme 24Care for people with Cardiovascular Disease 25Care for people with Chronic Respiratory Disease 26Care for people with Diabetes 27Smokefree West Coast 30Smoking Cessation 30Smokefree Pregnancy Incentives Programme 31Smokefree Service Co-ordination 32Health Navigator Service 33Health Checks for Clients of the Corrections Department 34Contraception and Sexual Health 35Palliative Care 36Mental Health 37Quality Improvement, Professional Development 38Workforce and Rural SupportSystem Level Measures Framework 38Professional and Practice Development 41Rural Primary Care Subsidies 43Financial Statements 45

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TRUSTEES’ REPORT

Time has certainly flown and I find myself presenting my fifth annual report as Chair of the WCPHO. In five years the organisation has grown in both staff and capacity. We have become a diverse organisation providing a wide range of nutritional and mental health services to both patients and practices alongside developing and overseeing clinical programmes within medical practices (as detailed later in the report).

To our dedicated and committed EO, Helen Reriti, our PHO staff, and our health provider teams thank you for all that you do to promote, maintain and restore the health of our community members, often with less than ideal resources.

I would also like to acknowledge my fellow Board members and our Clinical Governance Committee for your ongoing careful stewardship and clinical oversight of the health and wellness initiatives that we administer and/or deliver.

What has not changed in five years is our united view to work towards effecting change within primary health to improve access to services, ensure equity of service provision and remove needless barriers to accessing care. These remain goals of our organisation, the wider health alliance and the people working within these areas.

We have, for now, maintained low cost access to medical services with GP and nurse consults for most costing less than $20.00 and we will continue to advocate for this for our enrolled population. What we have not managed to achieve fully is continuity of care within our provider practices. This has repeatedly been signalled as an ongoing

concern due to the availability and distribution of qualified health professionals.

With the latest seismic shifts in health policy and the outcomes of system reviews I fully believe that our ongoing greatest improvements in health and wellness will come from increased integration and service provision from partners such as Poutini Waiora, NGOs, St John, pharmacies, local body authorities and other community-based entities with a health/wellness focus. This, combined with professionals working in new and diverse scopes of practice, will ensure that together we WILL achieve more!

For and on behalf of the West Coast PHO Board of Trustees

Julie Kilkelly Chair

Trustees’ Report - Presenting the Annual Report and Financial Statements for the year ended 30th June 2019.

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Attendance of Trustees at Board Meetings 1 July 2018 – 30 June 2019

Julie Kilkelly Independent Chair 6 Meetings

Anna Dyzel General Practitioner 5 Meetings

Meriem Wilson General Practice Administrator 6 Meetings

Tony Coll Grey District Council 4 Meetings

Graeme Neylon Buller District Council 4 Meetings

Jim Butzbach Westland District Council 6 Meetings

Marie Mahuika-Forsyth Runanga o Makaawhio 6 meetings

Lisa Tumahai Runanga o Ngati Waewae 4 Meetings

Carl Hutchby Poutini Waiora 6 Meetings

Nigel Ogilvie Practice Nurse 4 meetings

Back Row (from left): Graeme Neylon, Carl Hutchby, Jim Butzbach, Tony CollFront Row (from left): Meriem Wilson, Julie Kilkelly, Marie Mahuika-Forsyth Absent: Anna Dyzel, Lisa Tumahai, Nigel Ogilvie

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EXECUTIVE OFFICER’S REPORT

We are often asked about what we do and the purpose of our organisation. We are a primary care network, providing leadership, support and services to general practices, rural clinics and community organisations with the aim of ensuring West Coast people are well and healthy in their own homes and communities. Throughout this report you will see the activities that the PHO has been involved in through valuable partnerships and relationships with many organisations and groups across professions, communities and at the heart of primary care our general practice teams. It is important to take this opportunity to thank some of our key partners in this work, Poutini Waiora, Community and Public Health and the West Coast DHB. Without unity and willingness to work collaboratively we will not be able to realise the ongoing vision of providing accessible, easy to

navigate, culturally appropriate and connected-to-community services.

None of us missed the heartening news of the Government’s recent wellbeing budget, which has a huge focus on wellbeing initiatives being delivered through primary care. Before the announcement of the $1.9 billion lifeline for mental health and wellbeing services over the next five years, the West Coast Health Alliance was already well in progress with numerous areas of service redesign and innovation for the West Coast Mental Health & Addiction Services.

In August 2019 the PHO secured the contract with the WCDHB to provided suicide prevention coordination with a dedicated role based within the PHO mental health team. We believe having this dedicated role will be an effective way to ensure the development, delivery and ongoing evaluation of a robust, effective suicide prevention plan. The role coordinates work not only within primary care but across West Coast communities, other government agencies and community groups to ensure we are supporting wellbeing and responding to people’s needs when and where required.

A key focus for management this year has been to apply the principles of quality improvement across all of our delivered programmes and also

Nau mai, haere mai

Welcome to our 2018/2019 year in review.

This is my sixth report as Executive Officer and my eleventh year with the PHO and I am still coming to work each day feeling inspired and committed to ensuring West Coasters can live healthy lifestyles, having equitable access to health services with equitable outcomes for their health.

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internally within the organisation. This has been driven by the PHO’s approved submission to the Health Quality & Safety Commission (HQSC), the Whakakotahi 2018 project. Whakakotahi is a sector-led initiative that develops quality improvement capability in primary care, broadens the reach of primary care and reduces barriers to access. Taking part involves primary care providers partnering with the Commission on small-scale improvement projects of the providers choosing, focusing on an area of patient care they wish to improve. Our improvement project was in partnership with Poutini Waiora and focused on improving clinical outcomes for Māori with diabetes using a collaborative model of care. Lessons learned through this process have been invaluable to all areas of our organisation and general practice teams.

I want to say how appreciative I am to lead such a highly skilled and passionate team. I have welcomed some amazing staff members this year and farewelled others whose paths have led them elsewhere.

I would also like to take this opportunity to acknowledge and thank my Chair, Julie Kilkelly, and Board members for their governance, strategic influence and stewardship.

To the West Coast community: I challenge you to be the best that you can be by making small lifestyle changes that will have a significant outcome to your health and wellbeing. Be kind to yourself and those around you.

It’s not what we do once in a while that shapes our lives, but what we do consistently.

Kia ora rawa atu,

Helen Reriti Executive Officer

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SUBSIDISING ROUTINE ACCESS TO PRIMARY CARE

This is achieved by passing on the funding for “first level services” to all contracted practices, and “Very Low Cost Access (VLCA) funding” to a subset of practices, so that patients do not have to pay the full cost of their visits to the general practice.

Expenditure $6,207,314 (excl. GST)

All but one West Coast practice have their fees set to the maximum currently permitted under the VLCA scheme. The one non-VLCA practice joined the National Community Services Card (CSC) scheme from January 2019 allowing card holders to pay the same maximum co-payment as VLCA practices.

We aim to improve access to primary health care services by reducing the cost that patients pay each time they visit their medical centre.

Cost of co-payment during 2018-19 for VLCA practices

Children 0-13 FREE

Children 14-17 $12.50

Adults 18+ $18.50

Cost of co-payment during 2018-19 for Non VLCA practice

Non-CSC CSC holder

Children 0-13 FREE FREE

Children 14-17 $22.00 12.50

Adults 18+ $28.00 18.50

Adults 65+ $25.00 18.50

TARGET GROUP: all enrolled people in the PHO

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West Coast PHO Enrolled Population

Visits to medical centres

For the April to June 2019 quarter, 29,880 people were enrolled with the West Coast PHO. This is an increase of 151 compared with the same time last year.

The average number of people enrolled in the PHO during the year was 29,836.

This represents an average of 5 visits for each enrolled patient in the PHO. The average subsidy for each enrolled patient was therefore $236.96 (including GST) during the year, while the average subsidy per patient visit was $51.72 (including GST).

136,712 subsidised visits by

enrolled patients

Enrolments over time by ethnicity

Pacific

Māori

Other

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

Jul-

Sep

17

Jul-

Sep

18

Jul-

Sep

15

Jul-

Sep

16

Oct

-Dec

17

Oct

-Dec

18

Oct

-Dec

15

Oct

-Dec

16

Jan-

Mar

18

Jan-

Mar

19

Jan-

Mar

16

Jan-

Mar

17

Apr-

Jun

18

Apr-

Jun

19

Apr-

Jun

16

Apr-

Jun

17

Nu

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r of

Pa

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72,081 GP visits 64,631 nurse visits

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26,206

241

3262

26,206

240

3283

26,224

253

3311

26,240

253

3330

26,287

257

3311

26,312

246

3303

26,302

247

3329

26,774 26,364

244 251

3319 3300

26,476 26,230

257 250

3321 3295

26,236

289

3355

26,624 26,305

249 249

3312 3289

26,384 26,240

255 243

3321 3246

Access for Māori

Total enrolments have declined 3% over the five-year period from 1 July 2014 to 30 June 2019, while Māori and Pacific enrolments have increased 3% over the same period.

11% of total enrolments Māori

1% Pacific3% Asian

PHO Enrolments

Māori / Pacific enrolments Total enrolments

Jul 1

8

Jan

19

Jul 1

4

Jul 1

5

Jul 1

7

Jan

16

Jan

15

Jul 1

6

Jan

18

Jan

17

Mā

ori

/ Pa

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rolm

ents

Tota

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rolm

ents

0

5,000

10,000

15,000

20,000

25,000

30,000

0

500

1,000

1,500

2,000

2,500

3,000

3,500

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KEEPING PEOPLE HEALTHYExpenditure

The PHO spent $415,414 on the various ‘Keeping People Healthy’ programmes which include Breastfeeding Support, Health Promotion Community Activity, Green Prescription and Nutrition services.

This programme aims to improve breastfeeding rates and to create a supportive breastfeeding environment on the West Coast (because the evidence shows that infants who are NOT breastfed have a higher risk of developing chronic illnesses).

The service is delivered by Breastfeeding Advocates with a combined 0.8 FTE.

Data is now obtained from all providers, whereas previously only Plunket data was available. The following table shows collated West Coast breastfeeding results for this period from all providers.

It is also important to note that the Ministry of Health target for 6 months (65%) is for babies receiving any breastmilk; exclusively, fully or partially breastfed. The results below include those who are exclusively or fully breastfed for 6 week and 3 months. The 6-month result includes babies receiving any breastmilk. The results are shown as an average taken from the results of each quarter.

TARGET GROUP: Childbearing women and their whānau, those in high deprivation areas, young and Māori women.

Health professionals

6 Weeks exclusively or fully breastfed

3 Months exclusively or fully breastfed

6 Months exclusively, fully or partially

breastfed

West Coast Result 64% 61% 60%

West Coast Targets 75% 70% 65%

Māori Result 59% 48% 63%

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It is pleasing to see the increase in Māori babies receiving breastmilk at 6 months of age.


Lactation Consultancy

Anywhere Anytime

There were

168 Lactation Consultancy

clients in 2018/19

710Lactation Consultancy

contacts

55 were living in high deprivation areas

57 living rurally

15 <20 years of age

17%(29) of contacts made

with Māori mums

We have been successfully breastfeeding for a year and I must say I am pretty proud of us both - a huge milestone! I just want to thank everyone who has helped me.

I just wanted to say thank you because without your support I wouldn’t have managed to go so far breastfeeding. You do amazing stuff for people and I’m proud to be one of them.

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This programme continues to reach young Māori wahine and those living in deprived and rural locations.


Breastfeeding Advocates support mums and partners with ante-natal sessions regarding breast feeding and provide education sessions for general practices and community groups.

Breastfeeding Education 14 ante-natal sessions

7 Westport4 Greymouth1 Hokitika1 Hari Hari1 Reefton

9 Mum4Mums trained

1 of these mums was Māori

12 community and health professional sessions

Breastfeeding Advocates support breastfeeding mums, and provide training to volunteer West Coast women, to develop a support network for breastfeeding families across the Coast. Some of the ways this network of ‘Mum4Mums’ support other breastfeeding mothers is through providing breastfeeding advice, dispelling myths and helping mums overcome common issues that affect breastfeeding. Feedback from some Mum4Mums in 2019 was that they had supported 368 women, locally, nationally and internationally. This is from just some of our Mum4Mums and shows how extensively this network reaches and supports other women.

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Being on the course gave me weekly support during my breastfeeding journey, and the clarity to realise the difference between expectations and reality and how powerfully they can impact daily life and self-confidence. Armed with more knowledge I now feel that I’m able to answer people when they comment negatively or question mine or others’ parenting decisions, whereas before I would often shy away or just agree with them to not cause ripples. I think the honesty of what women, and mothers in particular, really experience is hidden for most people. Opening the conversation in such a safe way on the Mum4Mums course has shown me how I can open an honest conversation with friends and other women I meet.

I really enjoyed the M4M training!

I learnt some new information about breast feeding that I didn’t know, the trainer was very helpful and the lessons were informative. I now feel confident that I will be able to help other mums and am looking forward to the next time I get to breast feed as I feel more confident in what to do now.

Mum4Mums have shared some of their experiences:

August 2018 ‘Big Latch On’ – Westport

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Our Health Promotion/Community Activity coordinator supported West Coasters and general practice teams in 2018/19 in the areas of cardiovascular risk assessment, screening, immunisation, ‘smoke-free’, oral health, mental health and diabetes campaigns. This included delivering health promotion messages, staging and participating in events, and presenting community awards in recognition of health promotion activities.

Some examples of these types of activities include:

Ý The WCPHO participated in and supported the Kawatiri well-being hui in Westport in November 2018

Ý Valentine cards and appointments were sent to patients from two practices during the February 2019 Heart Month campaign, inviting them to complete their cardiovascular risk assessments. This was targeted at people who had not had their cardiovascular screen

Ý Posters were displayed in Greymouth High School for Smokefree May with ‘becoming and remaining smokefree’ messages promoted through conversations with students during their lunch breaks

Ý Smokefree display at The Warehouse in Greymouth Ý Promoted “gumboot Friday” – for helping get free and

timely counselling for children

Health Promotion Community Activity

Children’s Day, 3 March 2019 in Hokitika

Rusty attended Children’s Day in Hokitika.

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Rusty promoted “Letting Nature In” for mental health wellbeing month

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Each year one lucky recipient from each of our regions wins a Healthy Lifestyle Ambassador award.

This award is in recognition of significant changes each has made to their lifestyle to lead a healthier life. Each has also made contributions to promote and support healthy lifestyles in their communities, either by role modelling or supporting others to make lifestyle changes like their friends and family.

Healthy Lifestyle Ambassador Awards

2018 Healthy Lifestyle Award recipients (left to right): Greymouth winners: Eugenie Robinson, Madeline and Brad Bernard

Westport winner: Kayla (Kezzie) Griffiths

To be eligible and nominated for this award the individual should be:

Ý Exercising regularly Ý Be smoke-free Ý Eating healthily

There were two joint winners in the Grey District and one in Buller. There were no nominations for Westland this year.

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The Green Prescription programme supports West Coasters who are inactive and at risk of developing diabetes or cardiovascular disease to make regular exercise a way of life.

This is through: Ý individual and group exercise sessions in

each region Ý encouraging independent exercise Ý community based “Active You” programmes

Green Prescription (GRx)

455 West Coasters

participated in the Green Prescription

programme in 2018/197

pool passes were given to people

with diabetes enrolled in GRx

17% of these were Māori

Mental Health Awareness Week walk – Reefton

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It is very pleasing to see that ‘Elevated Body Mass Index’ and ‘Depression/Anxiety’ are the two largest conditions for all those referred this year. This recognises that physical activity and other lifestyle changes contribute markedly to improved health outcomes.


GRx Plus is a nutritional programme that works alongside GRx to provide individualised nutritional support for clients enrolled in the GRx programme, and for people with pre-diabetes.

The programme is also available for people with high cardiovascular risk. The goal of the programme is to reduce the incidence of diabetes, heart disease and to support people to achieve a healthy weight by improving access to nutritional advice, alongside healthy physical activity.

The GRx Plus programme is delivered by a dietitian at 0.6 FTE.

Dietitian clinics are held in Westport, Greymouth and Hokitika.

Green Prescription Plus

84 West Coasters

referred to the Green Prescription Plus

programme in 2018/19

76 Initial Dietitian

Consults

101 Follow-up Consults

TARGET GROUP: People with pre-diabetesPeople with high cardiovascular riskObese people from high need populations


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The Melon weight loss programme is an online, self-management support tool designed to help people achieve sustainable weight loss and focus on healthy habits as a path to health. The 16-week programme combines peer support via social media, health coaches and behaviour change tools to build daily habits which result in positive health outcomes. PHO Dietitians provide health coaching to West Coast participants.

The goal of Melon is to enable people within the enrolled population with a BMI >30 to take control of their health by giving them the tools, support, information, motivation and confidence to manage their health through the 16-week programme and then ongoing support through the app for as long as clients choose to use it.

Ý 63 enrolments into Melon

› 7 of whom did not accept the invite

› 47 reached the 16-week mark (some of whom started before 1 July 2018 and are not included in the enrolment numbers); 12 of the 63 enrolments are still within 16 weeks - not yet completed at 30th June 2019

My Health Survey outcome data:

Patients are prompted to complete this survey when they accept the Melon invite and at week 16. This survey aims to extract information about participants’ confidence in their ability to achieve their goals.

There are 8 questions, with each being scored out of 10. Twenty patients completed both surveys at week 0 and week 16. The total average scores for this group are:

Melon Weight Loss Programme

63 enrolled 75% completed

13% Male87% Female13% Māori

Initial Melon assessment (average) End of Melon (average) Result (average)

BMI (n-17) 40.21 38.74 -1.47

Weight kg (n-17) 115.22 109.89 -5.11

Waist cm (n-6) 115.22 109.89 -5.11

Outcome data:

Week 0 Week 16 Improvement

My Health Survey 42.90 59.35 + 16.45

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Programme participants feedback:

My coach was amazing with non-judgemental support. I felt important to her as if I were her only client.

The flexible time to use the Melon programme along with a coach that is encouraging and clearly supporting and non-judgemental was the most helpful for me.

My coach was fantastic. She was very helpful when I had questions or expressed my frustrations at myself.

Great use of coaching, supportive when needed, available at suitable times.

I don’t think you could improve Melon. My coach was very good. I stick to myself a lot so didn’t participate in the community posts but all the information the coach gave me was very helpful.

Thank you. I feel I’m getting somewhere for the first time in 45 years.

This programme is excellent and my coach was encouraging, helpful and reinforcing all the positives I had achieved.

Thank you for the top coaching – kept me encouraged and reassured and just good to talk it out and be directed to specific resources – which I then did look at. A valuable service. Is great that I can continue in an informal way. Thank you.

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Individualised nutritional support for consenting clients is offered in dietetic clinics in Greymouth, Hokitika and Westport. The target group for this programme are those with pre-diabetes, CVD risk of >15% and those who have a BMI > 30 with or without co-morbidities. The service priority areas are for those with BMI > 30 and high need populations. Phone consults are offered to clients who live in South Westland or other rural locations, who would find it difficult to make it into a clinic and for whom the online programme is not suitable.

The aim is to provide professional support that assists West Coasters towards a healthier future, using an evidence-based approach to help them achieve healthy lifestyle and activity goals.

These are interactive group education and self-management days for people with Type 2 diabetes, facilitated by the Dietitians and Diabetes Nurse Educators. Courses are one-off sessions (one initial and one follow up) designed to demystify the condition and support people to live well with diabetes.

General Practice Nutrition Clinics

Living Well with Diabetes Courses

23 attended ‘Initial’ and

10 attended follow-up courses

TARGET GROUP: People with pre-diabetesPeople with high cardiovascular riskObese people from high need populationsType 2 diabetesFamilies with an overweight child (≥5 years old)

261 West Coasters referred to Dietitian clinics in

2018/19


198 Initial Dietitian

Consults

186 Follow-up Consults

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CLINICAL PROGRAMMES AND SERVICES

Our funded clinical programmes assist West Coasters to access health care, with the purpose of reducing the risk of developing heart disease or diabetes and helping them to self-manage any existing long-term conditions they have.

Expenditure

The PHO spent $500,540 on the various clinical programmes and services.

This programme aims to identify individuals at risk of a cardiovascular event (heart attack or stroke) and diabetes, in order to provide early intervention and to reduce the incidence of heart disease or stroke.

The goal is:

Ý for 90% of those eligible to have a CVRA completed within the last five years

Ý ensuring individuals are on appropriate treatment Ý linking individuals with lifestyle programmes that

support healthy behavioural changes

Expenditure $32,568

SCREENING FOR CARDIOVASCULAR DISEASE AND DIABETES

2,158 Cardiovascular Risk Assessments (CVRAs)

were completed in 2018/19

9,907(87%) of eligible CVRAs have been

completed in the last 5 years

10%of these were for Māori

87%of eligible Māori have been screened in the last 5 years

71% of eligible

Māori men aged between 35 and 44 years have

been screened in the last 5 years

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Treatment of those identified as high risk (CVRA >15%) aims to reduce the 5-year risk to below 15%, through:

Ý all identified smokers being given brief advice and offered support to quit

Ý recommending lifestyle interventions e.g. diet, physical activity, weight management and relevant referrals

Ý commencement of optimal pharmacological treatment Ý regular follow-up and monitoring

Expenditure $20,870

TREATMENT FOR THOSE IDENTIFIED WITH HIGH CARDIOVASCULAR RISK

1,399 Individuals (65%) were identified

as having a risk less than 10%

low risk

665 Individuals (31%) were identified

as between 10-20%moderate to high risk

94 Individuals (4%) were

identified as >20%very high risk

Cardiovascular Risk <10%:

Cardiovascular Risk between 10-20%:

Cardiovascular Risk >20%:




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It is pleasing to see the ongoing and increased prescribing of statins, ACE inhibitors or A2 receptor blockers to date for people identified with high cardiovascular risk.

0%

5%

10%

15%

20%

25%

% on statin

% on beta blocker

% on ACE inhibitor

% on Aspirin

% on A2 receptor

% patients at high risk of a CVD event on relevant medications

2015-16 2016-17 2017-18 2018-19 YTD

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The LTC programme aims to improve health outcomes and self-management for people who are living with a long-term chronic condition.

The goal is to enhance the management of cardiovascular disease (CVD), diabetes and chronic obstructive pulmonary disease (COPD), and to achieve equity of health outcomes for Māori, Pacific peoples and those living in high deprivation areas.

Interventions are designed to:

Ý reduce inequalities in treatment and health outcomes for High Need groups

Ý ensure patients are on appropriate treatments Ý link patients with lifestyle programmes that can

support them to make any required behavioural changes

People enrolled in this programme receive:

Ý an in-depth annual review for each condition Ý a package of care based on their level of need Ý a jointly developed care plan Ý referral to other PHO programmes, community

support programmes, social services, community pharmacy and other health professionals as required

LONG TERM CONDITIONS (LTC) PROGRAMME

TARGET GROUP: People with CVD, Diabetes and COPD

4,045 People were enrolled in the LTC programme at 30 June

2019

Māori make up 7% of the enrolled population

>45 years (the prime age group for LTC enrolees)

This is 14% of the PHO’s enrolled population

Services provided as part of the LTC programme are funded by Care Plus, Diabetes, and Services to Improve Access funding streams.

The West Coast PHO expanded the LTC mental health programme in Westport to the Westport private practice. To 30 June 2019, 31 people from both practices were newly enrolled in this programme, 6 of these were for Māori. 42 people had an annual review, 2 of these were Māori. There were 86 quarterly follow-ups, 11 of these were for Māori.

Expenditure $157,948

7% of these

were Māori

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This programme aims to enhance the management of CVD and to improve the equity of health outcomes, particularly for high need patients (Māori, Pacific peoples and those living in high deprivation areas). 6% of the enrolled population have been identified with CVD.

Expenditure

CVD care is included within the $157,948 LTC expenditure.

Of those people with CVD who have been reviewed, 88% were not smoking. Of those Māori reviewed in the June quarter, 71% were not smoking and 90% of other ethnicities were not smoking. For those who are smoking there are several cessation services to choose from, all promoted across the West Coast.

CARE FOR PEOPLE WITH CARDIOVASCULAR DISEASE (CVD)

TARGET GROUP: All people with CVD

1,548 CVD reviews (83%)

completed in 2018/19

5% of these

were Māori

1,868 enrolled people have been identified with CVD on the

West Coast

currently smoking

not smoking

0%10%20%30%40%50%60%70%80%90%100%

2015-16

84% 86% 85% 88%

16% 14% 15% 12%

2016-17 2017-18 2018-19 YTD

Percentage CVD Patients who are non-smokers

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This programme aims to improve the quality of life and self-management skills of people living with chronic respiratory disease. This condition is also known as Chronic Obstructive Pulmonary Disease (COPD) or Chronic Obstructive Respiratory Disease (CORD).

Key activities:

Ý review both the clinical and self-management of the patient’s condition

Ý provide an action plan to manage exacerbations Ý all identified smokers are offered brief advice and

support to quit Ý all patients are offered annual flu vaccination, and

pulmonary rehabilitation where applicable Expenditure

COPD care is included with the $157,948 of LTC expenditure.

CARE FOR PEOPLE WITH CHRONIC RESPIRATORY DISEASE

TARGET GROUP: All people with COPD

460 COPD reviews

completed in 2018/19

7% of these

were Māori

68% had a Flu vaccination

at 30 June 2019

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This programme aims to improve health outcomes and quality of life of people living with diabetes and to improve the equity of health outcomes, particularly for high need patients (Māori, Pacific peoples and those living in high deprivation areas).

Key activities:

Ý review both the clinical and self-management of each patient’s condition

Ý retinal screening clinics held quarterly in different regions across the West Coast

Ý support practices to ensure as many patients as possible benefit from this programme

Ý review and address inequalities in health outcomes

CARE FOR PEOPLE WITH DIABETES

TARGET GROUP: People with diabetes

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Diabetes care is included within the $157,948 LTC expenditure; an additional $50,450 was spent on retinal screening and $269 on Diabetes Care Improvement Package (DCIP).

1,118 (97%) Diabetes

reviews completed in 2018/19

1,158 enrolled people identified with diabetes on the

West Coast

11% were for Māori


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The West Coast PHO participated in the Health Quality Safety Commission (HQSC) 2018 Whakakotahi quality improvement initiative.

The West Coast project seeks to recreate the way diabetes, pre-diabetes and high cardiovascular risk care is delivered on the West Coast to improve the patient’s experience of care, their self-management ability and their health outcomes. The project is a collaboration between the West Coast PHO, Poutini Waiora (West Coast Māori provider) and the West Coast DHB. It is being trialled in one general practice in the Westport, focussing on diabetes care for Māori and utilising Kaiarataki and nurse-led services, with medical/specialist support as needed. The aim is to improve access, equity and integration of services for Māori with diabetes, with a quality improvement oversight to ensure that the project meets appropriate quality standards.

Members of the Whakakotahi project team

From March to the end of June 2019, 50% of Māori patients with diabetes (within the project practice) have been supported to complete timely annual and quarterly reviews. Reviews are timed to coincide with patient’s repeat medications and when they are

The number of people with a cholesterol in the desired target range (<4) is 39%, an increase from 34% YTD from the 2017/18 year. It is noted that of those identified with elevated cholesterol (>4), 64% are appropriately medicated on a statin. 68% of people reviewed have good diabetes control and 93% of people have had their retinal screening in the last 2 years.

0%

20%

40%

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100%

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% cholest < 4

% not

smoking

% retinalscreened

last 2 years

% on kidney protective

medications

Clinical outcomes from diabetes annual reviews conducted

2015-16 2016-17 2017-18 2018-19 YTD


Diabetes Care Improvement Package includes:

Ý Seven pool passes for people with diabetes who are enrolled in Green Prescription

Please note: There was no podiatry service (for those not eligible for DHB-funded podiatry) available in 2018-19.

481 retinal screens

completed

7 pool passes given to GRx clients with

diabetes

7 Living Well with

Diabetes courses held:33 attendees

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due for their regular review. Using a whānau ora approach, patients have received holistic care through interdisciplinary case reviews, diabetes education for patients and their whānau, referrals to appropriate health and social services, and wrap-around support to assist them to access these services. This has seen an increase in access to and engagement with services, and a reported improvement in self-management and well-being by many Māori patients who have used this service.

The next step is for the model to be expanded to other West Coast practices and other long-term conditions, to support equity of health outcomes for Māori, Pacific and high need people who are living with long-term conditions.

Living Well with Diabetes courses:

These courses are designed to give people with diabetes the opportunity to engage in small groups, learning about living well with diabetes. Seven ‘Living Well’ courses held, 33 people attended.

Enhanced retinal screening clinics:

These clinics provide a package of care for people whilst attending their retinal screening appointment. Individuals have the opportunity to have relaxed discussions with: a diabetes nurse specialist, Dietitian, mental health counsellor, health promoter and Green Prescription coordinator. Along with health professional advice there are numerous resources available for people with diabetes and their families to take home.


SMOKEFREE WEST COAST

The aim of the “Coast Quit” smoking cessation programme is to reduce tobacco smoking through increased availability and choice of smoking cessation options in the community.

Key activities: Ý Programme provided by trained nurses, GPs, rural nurse

specialists, pharmacists and pharmacy staff across the West Coast

Ý Participants are phoned at 3-4 months post quit date to ascertain outcome with the Coast Quit provider

Ý Feedback of results is provided to all practices Expenditure $28,415

Smoking CessationTARGET GROUP: West Coasters who smoke

335 people enrolled in Coast Quit in

2018/19(304 – Practices,31 – Pharmacies)

13% of Coast Quit enrolments were Māori

3 month outcomes:

34% quit rate for

326 clients phoned

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83% abstinenceoutcome for women

84% for partners

The Smokefree Pregnancy and Newborn Incentives Programme provides cessation counselling and a voucher incentive schedule to promote successful cessation over a 12 week period during pregnancy, and for 14 weeks after the birth. This programme is also extended to partners of pregnant women who wish to quit smoking.

Key activities: Ý Oversight of the smokefree pregnancy and

newborn incentives programme, delivered by the DHB and Oranga Hā, Tai Poutini cessation counsellors

Outcomes:

Ý The programme was extended from pregnancy to cover the 18-week newborn phase from July 2018 and included partners from February 2019

Ý For the 12-week programme, the abstinence rate was 83% for women and 84% for partners

Expenditure

SPIP programme is included in the Smoking Cessation $28,415 expenditure.

34 pregnant women

+25 women (newborn phase)

12 partners enrolled in SPIP

in 2018/19

Smokefree Pregnancy and Newborn Incentives Programme

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The purpose of this service is to reduce the prevalence of smoking on the West Coast by supporting health providers and other community groups or agencies to promote ‘smoke-free’, and to increase the uptake of effective smoking cessation interventions. This service is delivered by a 0.8FTE co-ordinator.

Key activities: Ý co-ordinating a range of smoke-free activities,

and promoting smoke-free environments Ý supporting a range of cessation options and

programmes across the region, including the smokefree pregnancy and newborn incentives programme

Ý monitoring and promoting the secondary care tobacco health target: 95% of patients who smoke and are seen by a health practitioner in public hospitals are given brief advice and offered support to quit smoking

Ý monitoring and promoting the primary care tobacco health target: 90% of patients who smoke and are seen by a health practitioner in primary care are given brief advice and offered support to quit smoking

Ý organising training opportunities for all smoking cessation providers

Ý working with the West Coast Tobacco Free Coalition to achieve the national goal of Smokefree Aotearoa-New Zealand 2025.

Ý National Training Service approved trainer status for Coast Quit programme and ABC intervention achieved.

Smokefree Service Co-ordination

Secondary Care Target result:

91%Offered support to quit

at 30 June 2019

Primary Care Target result:

96%Offered support to

quit at 30 June 2019

7Smokefree ABC training

44 attended

44 attended Coast Quit training

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There were:

3,738 phone calls made,

3,558 contacts with

other agencies,

2,724 face to face contacts

with clients in 2018-19

1,840clients

HEALTH NAVIGATOR SERVICE

The service assists high need patients with Long Term Conditions (LTCs) to access appropriate social and health care services. The service is firmly embedded within the wider health and social care system across the region.

The Health Navigators have a total FTE of 4.3. They undertake a wide variety of activities and functions when providing navigation services especially to older adults living with multimorbidity and social complexity in a rural location. The service continues to be well used by general practices, secondary care services and community organisations as the service is recognised as contributing to improving the care experience of their clients.

Progress 2018/19TARGET GROUP: LTC patients with complex social issues

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HEALTH CHECKS FOR CLIENTS OF THE CORRECTIONS DEPARTMENTThis service provides free acute care and general health check-ups for clients of the Corrections Service, many of whom do not have a general practitioner.

This service also provides subsidised prescriptions for these clients via all West Coast community pharmacies.

This programme continues to benefit a small number of high need individuals.

It is pleasing to see an increase in service use from 140 in 2017-18. This is attributed to a collaborative partnership with Poutini Waiora who continue to promote this service at health hui and to users of their service.

Expenditure $3,644 149 Corrections claims

made by clients of the Corrections service in

2018-19

20% of these were

Māori

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1,587 Contraception and sexual health visits

in 2018/19

CONTRACEPTION AND SEXUAL HEALTH

This service aims to reduce pregnancy rates in the under 25-year age group and to improve access to sexual health services. It removes financial and social barriers to accessing contraception and primary sexual health services for young people, particularly those at risk of ill health, injury and unwanted pregnancy.

Services available from all general practice teams and rural clinics:

Ý Contraception and sexual health consults Ý Emergency Contraception ECP consults

Services available from community pharmacies:

Ý No prescription co-payment fees Ý ECP consults

Key Features

Ý accessible Ý acceptable to young Māori Ý range of access points including practices, rural

clinics and community pharmacy

Expenditure $33,702

17% of these

were Māori

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PALLIATIVE CARE

This service aims to reduce the financial barriers for patients and their whanau receiving general practice care in the terminal stage of their illness.

The programme continues to cover costs of visits to the general practice, home visits, nurse visits made on behalf of patients by palliative care nurse specialists, and some part charges for medication used in a palliative setting for enrolled palliative care patients.

Additionally, the PHO funds pharmacy palliative medicines for users of the service. This funding covered 106 patients, averaging $43.00 per patient, with a total spend of $12,869.47 for the year.

Expenditure $32,048

219 people were assisted by the programme by the end of June 2019

207 nurse visits

234 surgery visits

161 home visits

7% were Māori

Plan the healthcare you want in the future and for the end of your life

My Advance Care Plan & Guide

Name:

Date:

www.hqsc.govt.nz/our-programmes/advance-care-planning/

Plan the healthcare you want in the future and for the end of your life

My Advance Care Plan & Guide

Name:

Date:

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1,063 requests for assessment

as at 30 June 2019

4,889 counselling sessions

6,830 phone contacts

1,179 Patients attended Brief

Intervention Counselling

MENTAL HEALTH

The Mental Health programme which includs both the Brief Intervention Counselling (BIC) and Suicide Prevention Coordination Service (SPC), aims to support West Coast General Practices Teams (GPTs) and the community to improve health outcomes and quality of life for people with mental health needs. Expenditure $550,943 Key Activities: Ý training requests from GPTs for adults and young people and, in

relation to young people only, from school counsellors, relevant social agencies, family and youth themselves

Ý provision of up to six fully-funded BIC sessions (or up to twelve sessions with young people where other relevant people are involved) for those identified as meeting criteria

Ý facilitation of Extended Consultations by GPs and Practice Nurses with enrolled patients who have mental health needs

Ý develop the suicide prevention coordination role on the West Coast

Brief Intervention Counselling Ý continuation of brief intervention to youth and adults across the

West Coast region (estimate 3% of enrolled population), were managed by our team of six full-time equivalents

Ý work collaboratively with Child and Adolescent Mental Health Services (CAMHS), Pact and Homebuilders for youth referral across the Coast

Ý supported secondary mental health services with psychotherapies

Ý offered web-based emotional wellness coaching programme option for clients on the waiting list

Ý supported the roll out of the Long Term Conditions programme in Westport for people with mental health conditions

Ý weekly “mindfulness and meditation” group sessions held for adults

Suicide Prevention Ý employing and establishing the suicide prevention coordinator

role for the West Coast which commenced August 2018 Ý facilitating and supporting the West Coast Suicide Action Group

and monitoring the delivery of actions against the West Coast Suicide Prevention Action Plan 2018-2019

Ý providing community suicide prevention training opportunities e.g. Mental Health 101

Ý development of a West Coast Suicide Postvention Response plan Ý work collaboratively with community partners in the suicide

prevention space, for example delivering and developing the ‘Responding to Mental Distress in Schools’ programme as part of schools’ staff professional development

TARGET GROUP: Enrolled patients of West Coast practices, 12 years of age and over, with mild to moderate mental health concerns

It was an amazing experience and has helped me and my family tremendously. (Youth).

Truly life changing, and also some great mental tools for managing my mind. (Adult).

256 youth

923 adult

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QUALITY IMPROVEMENT, PROFESSIONAL DEVELOPMENT, WORKFORCE AND RURAL SUPPORTExpenditure

The West Coast PHO spent $1,229,790 on its various Quality Improvement, Professional Development Activities and Workforce and Rural Support.

The System Level Measures Framework aims to improve health outcomes for people by supporting DHBs to work in collaboration with health system partners (primary, community and hospital) using specific quality improvement measures. It provides a foundation for continuous quality improvement and system integration to improve patient outcomes. The following are the submitted results for the end of June 2018 to Ministry of Health:

System Level Measure Improvement Milestone Achieved Result

Ambulatory Sensitive Hospitalisations (ASH) 0-4 year olds

95% of pre-school children enrolled in DHB-funded oral health ser-vices. û 90%

70% of Māori babies are breastfeeding at three months. û 48%

Acute hospital bed days

60% of Māori, 65 and older, have received an influenza vaccine - at the end of the funded influenza season (31 Dec 2018).

û 49% The National result for this group was 45%.

90% of Māori smokers or ex-smokers registered at the Buller Health practice, aged 35 years or older, receive spirometry screening and lifestyle coaching.

û 22%

90% of eligible Māori aged 35-44 years have had a CVD risk assessment in the last 5 years. û 71%

Amenable mortality

70% of eligible women (in all population groups) have had a breast screen in the past 2 years. ü As at 31st March 2019 71%

Long Term Conditions ManagementA model to improve capacity of primary care to manage those with long term mental health issues is agreed.

üModel agreed for Westland June 2019

Less than 30% of children identified as obese in the B4SC programme declined a referral. ü As at 31st May 2019 20%

Patient Experience

50% of consumers discharged from the mental health inpatient service have completed a patient experience survey. û 48%

Establish a baseline % of patients that have completed a survey following a contact with primary care. ü 19%

40% of patients have provided an email address to practices, to enable participation in the primary care experience survey. û

This metric has not been reported back to the PHO by the survey provider since November 2018 - at which time the West Coast result had increased to 29%.

Smokefree Infants 75% of women (both Māori and non-Māori) set a quit date following refer-ral to the Smokefree Pregnancy Incentives Programme. û

40%This was an improvement from 20% in 2017. The number of Māori women engaged was <10 and therefore % result is not reported.

Youth Access to and Utilisation of Youth Appropriate Health Services

50% of young people who present to ED with self-harm or suicidality and are discharged to the community were referred to the PHO Brief Intervention Counselling service.

û

17%However, if those supported by DHB Community Mental Health teams or TACT are also included, this result improves to 61%.

System Level Measures Framework (SLMF)

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Brief advice and cessation support to smokers was 96%, exceeding the programme goal of 90% for the year ending June 2019. Smoking status recorded was 100%, exceeding the goal (90%).

This health target is for 95% of infants to have completed their primary course of immunisations by eight months of age. The West Coast PHO was below target, with 75% of infants immunised at 30 June 2019. This equated to 4 children (of those consented) needing to be vaccinated to reach 100%. There are 16 parents who have declined/opted their children off.

2018/19 Health Targets Performance results

Expenditure Incentive Payments to Contracted Providers was $167,947

CORNERSTONE® ACCREDITATION It is a contractual requirement that PHOs ensure that all of their contracted providers meet the Foundation Standard by no later than 1 July 2017. Practices that are currently CORNERSTONE® accredited will be considered to have met the Foundation Standard.

West Coast practices that are currently CORNERSTONE® accredited with the Aiming for Excellence standard are:

Ý Westland Medical Centre Ý Rural Academic General Practice Ý Reefton Medical Centre Ý High Street Medical Centre Ý Karamea Medical Centre Ý Ngakawau Medical Centre Ý Greymouth Medical Centre Ý Buller Medical Services Ý Coast Medical Ltd Ý South Westland Area Practice Ý Lake Brunner Rural Clinic

Standing Orders Training The West Coast Standing Orders Project: Ý The West Coast PHO continues to support the progression of

‘Standing Orders’ for West Coast practice staff. Part of this project includes access for practice staff to healthLearn – a Canterbury DHB educational initiative that includes online training, including standing orders courses for nurses, with associated educational points for staff portfolios. The healthLearn standing orders programme is aligned with the Ministry of Health’s Standing Orders Guideline 2016 and is flexible enough to be used across rural and urban West Coast and Canterbury primary care, to expedite care for patients.

SECO – Safe and Effective Clinical Outcomes Ý The West Coast PHO continues to work closely with the University of

Otago and the Department of General Practice and Rural Health to deliver SECO training for the Rural Nurse Specialists, as an adjunct to the standing orders training. SECO provides practical training that will support the decision-making process of standing orders usage.

Ý The PHO delivered its first SECO clinic to nurses from Greymouth Medical Centre and Poutini Waiora.

Expenditure $4,672

10 Rural Nurse Specialists

attended SECO training

9 Practice and Kaupapa Māori Nurses attended SECO training

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SECO CLINIC

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OUTCOMES

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CLINICAL


This programme supports the continuing education and professional development of staff employed by all member practices. This includes local workshops and study days, video-linked evening education sessions, and funded access to conferences and training opportunities mostly outside of the West Coast.

The CME (Continuing Medical Education) programme for 2018/19 has been highly successful and much of this can be attributed to a closer working relationship with the Rural Learning Centre (RLC) at the West Coast DHB. This has allowed the West Coast PHO and RLC to piggyback training sessions with each other, meaning greater opportunities for more staff to attend sessions.

Expenditure

The West Coast PHO spent $38,403 on Professional and Practice Development.

PROFESSIONAL AND PRACTICE DEVELOPMENT

408+ attended local

study days in 2018/19

27 PHO

orientation day

38 PHO weekend

conference

192Continuing Medical Education sessions

14Contraception

and sexual health courses

10+PHO

orientation individual

10+sessions PHO presentations to practice and

other health professionals

35 Attended 3 Quality

improvement workshops

52 Smoking cessation

training

40 Health Literacy

training

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Clinician attendance at various workshops:


Practice staff participated in a Quality Improvement workshop at

Greymouth Medical Centre

‘Patient Dashboard’ promotion at Reefton Medical Centre –

encouraging patients to activelyengage with their health screen-ing and keep these up to date to

reduce their clinical risk.

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Jake Bailey – keynote speaker

This funding aims to assist with sustainability of the workforce through initiatives aimed at supporting retention and recruitment of all primary health professionals in rural communities, including support for after-hours care.

The Rural Service Level Alliance (SLA) is made up of the PHO Clinical Governance Group and contracted providers who receive rural funding. The purpose of the Rural SLA is to recommend the distribution of the allocated rural subsidy funding in the West Coast region, to help ensure the sustainability of primary health care services for rural populations.

West Coast practices receiving this rural funding are:

Ý South Westland Area Practice Ý Westland Medical Centre Ý Reefton Medical Centre Ý Coast Medical Ltd Ý Buller Medical Services Ý 95% of rural funds are paid to the practices

listed above Ý 5% of the funding is retained by the PHO.

Expenditure $996,317

The West Coast biennial weekend conference was held in November 2018 with 38 attendees. Significant planning and organisation for this event occurs and facilitation of the programme speakers and attendees.

RURAL PRIMARY CARE SUBSIDIES TARGET GROUP:

Rural service providers contracted to the PHO

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Directory 46

Statement of Comprehensive Revenue and Expense 47

Statement of Financial Position 48 - 49

Statement of Changes in Net Assets 50

Notes to the Financial Statements 51 - 64

Independent Auditor’s Report 65

FINANCIAL STATEMENTS

For the year ended 30th June 2019

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PO Box 544, Top Floor,163 Mackay Street, GreymouthTelephone: (03) 768 6182 Fax: (03) 768 6184www.westcoastpho.org.nz

Cover Photo:© Anne Hines,

Health Promotion Coordinator WCPHO

ANNU 201819 ANNUAL REPORT … · community services. None of us missed the heartening news of the...

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Transcript of ANNU 201819 ANNUAL REPORT … · community services. None of us missed the heartening news of the...